Supply postcode decides on therapy

Regional differences: Therapy often depends on postal code

09/02/2014

In the various regions of Germany, there are sometimes clear regional differences in some therapies, surgeries and diagnoses. For her „Fact check health“ The Bertelsmann Foundation regularly analyzes such differences.

Negative effects for the patients
Actually, one should assume that factors such as the type and severity of a disease or the age of a patient are crucial for the prescribed medical treatment. But experts complain that this is not always the case and circumstances such as the density of specialists or doctor fees have influence. Healthcare researcher Professor Gerd Glaeske from the University of Bremen says: „There are always differences that astonish.“ And even with the diagnoses such differences are detectable. This had a negative impact on patients, as they often did not receive appropriate treatment. In addition, this would incur unnecessary costs.

In some regions almonds are removed eight times as often
For her „Fact check health“ The Bertelsmann Foundation regularly analyzes such differences. For example, it has been found that children in some regions are up to eight times more likely to remove tonsils than in other areas. For example, 109 out of 10,000 children were operated on in the Bavarian city of Schweinfurt, while only 14 in the Thuringian district of Sonneberg. In northeastern Germany, children are prescribed antibiotics twice as often than in the south.

Family doctors prescribe more antibiotics than pediatricians
The reasons for this are not necessarily due to the fact that people in one area are healthier than others. „In individual cases, such differences can often not be explained exactly“, so Glaeske. He continues: „There are suspected factors, but little evidence.“ As is known, for example, that general practitioners antibiotics, for example, a viral infection; On average, more senselessly prescribe than pediatric or ENT doctors. For example, 33 percent of primary care physicians prescribed antibiotics for non-purulent otitis media, which rarely uses antibiotics. However, only 17 percent of the pediatricians and only 9 percent of these probably did the most competent ear, nose and throat doctors. Glaeske explained that in rural areas, where especially the family doctor is visited, rather more antibiotics would be taken.

Rapid increase in ADHD diagnoses
According to the fact check also the number of ENT clinics in the respective region play a role in the almond operations. For example, children in circles with several large facilities would be operated more frequently. Also striking is the influence of doctors in attention deficit syndrome (ADHD). „There was a rapid increase in diagnoses and drug prescriptions. Particularly striking is the Würzburg area“, Thomas Grobe from the Institute for Applied Quality Promotion and Research in Health Care. In 2011, about 6.5 percent of boys aged 10 to 12 were prescribed an ADHD drug such as Ritalin nationwide. In Lower Franconia, it was with 13.3 percent more than twice as much.

Educational level and age of parents influence diagnosis
Since ADHD drugs are prescribed by child and adolescent psychiatrists and the number of specialists is manageable, relatively few of them could significantly influence drug prescriptions in a locality. The level of education as well as the age of the parents also influence the diagnosis of ADHD. „Children of unemployed parents are more frequently affected“ so rough. „And there is evidence that children of younger parents have a higher risk of diagnosis.“

The East is sicker than the West
For the adult population, regional differences are mainly attributable to the age structure, said Uwe Repschläger, Head of Corporate Management at Barmer GEK: „The age difference is the absolute primary factor explaining that the East is much sicker than the West.“ The reason for this was the emigration of many young East Germans to the western federal states. „The 'sickest' state is thus Saxony, the 'healthiest' Baden-Württemberg.“ The 80 chronic diseases, for which clear definitions were defined in the course of the risk compensation of the health insurance companies, are particularly suitable for the analysis of regional differences. „43 percent of our insured have at least one of these diseases“, so repeater. Grobe explained that, for example, there are more and more cardiovascular diseases in the new countries: „The inner German border can be read on the high blood pressure diagnoses.“

240 hospital stays per 1,000 inhabitants
Even in Caesarean sections, the differences in the countries are enormous. In the Saarland, for example, a good 37 percent of women gave birth by caesarean section in 2012, compared to just under 24 percent in Saxony. The „Fact check health“ also found a connection with the socio-economic situation in knee joint operations. Thus, in affluent circles usually more people received an artificial knee joint. In the approximately 2,000 German clinics in 2012, a total of 15.7 million patients came under the knife. This was a record 300,000 times more often. In Germany, according to the Organization for Economic Co-operation and Development (OECD), 240 hospital stays per 1,000 inhabitants per year were treated as inpatients by more than in any other industrialized country.

Technology credibility and price structure as reasons
„We have a high performance system, but in some areas there is some imbalance“, says Professor Fritz Uwe Niethard, Secretary General of the Orthopedic Societies DGOOC and DGOU. One of the reasons for this is the great belief in technology. „In many a case where an operation is scheduled, another treatment would be more appropriate at first.“ The price structure is another cause, as the example of the spine operations shows. „Their number is currently in a dynamic upward movement, with the growing number of seniors alone can not explain that.“ Also, studies would show that many of the intervertebral disc surgery are superfluous. A general practitioner receives 120 euros per patient per year for conservative treatment with physiotherapy and painkillers. In contrast, around 12,000 euros would be paid for the operation.

The German liability law also plays a role
Repeater says: „It would be best not to set the incentives for physicians in the future so that more of fast-acting surgery is better compensated.“ However, in addition to the financial aspect, the German liability law plays an important role. „Often, a doctor worries about possible claims much more than he would have at the present symptoms.“ At this point, Glaeske sees an important starting point: „It would be nice if doctors who heard hoofbeats would first think of horses again - and not on zebras.“ (Ad)